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Set up a billing provider

A billing provider is the provider or company that appears on billing records for services delivered through your organization.

Billing provider details usually include the legal provider name, National Provider ID (NPI), federal tax ID, taxonomy code, Medicare Part B participation, and billing address.

Before you start​

You need:

Choose a billing provider setup workflow​

Billing providers are set up manually in RehabAlpha.

Use manual setup when you need to add a billing provider's legal name, billing identifiers, and billing address. The import tool does not create billing provider records.

Manually create a billing provider​

  1. Open Billing providers.
  2. Click New billing provider.
  3. Enter the billing provider Name.
  4. Enter the National Provider ID (NPI) when available.
  5. Enter the Federal Tax ID when available.
  6. Enter the Taxonomy code when available.
  7. Select the Medicare Part B participation status when it applies to the billing provider.
  8. Enter the Billing address, including street address, city, state, ZIP code, and ZIP+4 when available.
  9. Add tags or notes when helpful.
  10. Click Save.

RehabAlpha creates the billing provider and adds it to the organization's billing provider list.

Add billing identifiers​

Use the billing provider's official billing identifiers when you have them.

  • National Provider ID (NPI) identifies the billing provider.
  • Federal Tax ID identifies the tax entity used for billing.
  • Taxonomy code describes the provider type or specialty.

Keep these identifiers on the billing provider record instead of repeating them in notes or facility setup.

Add Medicare Part B participation​

Use Medicare Part B participation to record the billing provider's relationship with Original Medicare Part B:

  • Select Participating when the billing provider agrees to accept assignment on all covered Original Medicare Part B claims.
  • Select Non-participating when the billing provider has not entered the Medicare participation agreement and may accept assignment claim by claim.
  • Leave the field blank when the status has not been recorded or does not apply.

This field does not represent Medicare enrollment, Medicare Advantage network status, or commercial insurance network status.

Add the billing address​

Use the billing address where billing records should identify the provider.

  1. Open the billing provider.
  2. Click Details.
  3. Click Edit.
  4. Find Billing address.
  5. Enter the street address, city, state, ZIP code, and ZIP+4 when available.
  6. Click Save.

ZIP+4 requires a ZIP code.

Manage billing provider details​

  1. Open Billing providers.
  2. Find the billing provider in the list.
  3. Click the billing provider name.
  4. Click Details.
  5. Click Edit.
  6. Update the basic details, billing address, tags, or notes.
  7. Click Save.

Changing a billing provider's name or identifiers affects how that billing provider appears anywhere it is used in RehabAlpha.

Assign a billing provider to a facility​

After creating the organization billing provider, add facility rules that determine when RehabAlpha uses it:

  1. Open Facilities and select the facility.
  2. Click Billing.
  3. Click Add rule.
  4. Choose whether the rule applies to a Specific payor or Payor type.
  5. Select the payor or payor type and the Billing provider.
  6. Enter the inclusive Start date and, when applicable, End date.
  7. Click Save rule.

Rules for the same payor cannot have overlapping effective dates. Use consecutive rules when the billing provider changes over time. Billing provider rules select the provider used for billing; reimbursement arrangements remain part of the payor setup.

Manage billing provider settings​

  1. Open the billing provider.
  2. Click Settings.
  3. Update the available settings for that billing provider.

Depending on your permissions, the settings page may include danger-zone actions.

You should know​

Only admins can add or delete billing providers.

Do not delete a billing provider if it is still needed for billing, invoices, claims, contracts, reporting, or as the presumed billing provider on a direct-billing episode.

Create separate billing provider records when your organization bills under different legal providers, NPIs, tax IDs, taxonomy codes, or billing addresses.

Frequently asked questions​

Is a billing provider the same as a facility?​

No. A facility is where care is delivered. A billing provider is the provider or company identified for billing. One organization may have one billing provider or multiple billing providers depending on how billing is structured.

Is a billing provider the same as a therapist or physician?​

No. Therapists and physicians are people who appear in clinical, scheduling, signature, or staffing workflows. A billing provider is an organization-level billing record.

Can I create more than one billing provider?​

Yes. Create multiple billing providers when your organization needs distinct billing identities, such as different legal names, NPIs, tax IDs, taxonomy codes, or billing addresses.

Where do I enter payor or patient coverage details?​

Enter payor details in Payors and patient-specific coverage details on the patient's Coverages page. Billing provider records should store the provider identity used for billing.

What to do next​

After the billing provider is set up, continue setting up facilities, payors, and patients.